17-105811 PERMIT APPLICATION
CITY.O
Federal Way PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
253-835-2607+FAX 253-835-2609+perllREt iOEi 'f[d"�ei.Dav com
PERMIT NUMBER ( 7 _ to
3 3 it Fp DEC 0 5 2017
TARGET DATE
SITE ADDRESS CQm / IFLOPMENT
34410 16th Ave S
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 500 2 5 0 0 9
0 _ 0 0 4 0
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING 1 FIRE PREVENTION
NAME OF PROJECT Round Table Pizza
Remove existing Fire Alarm Notification device for wall repair. Reinstall existing
PROJECT DESCRIPTION
Detailed description of work to Fire Alarm Notification Device after wall repair.
be included on this permit only
NAME PRIMARY PHONE
Federal Way Marketplace West
PROPERTY OWNER MAILING ADDRESS E-MAIL
30300 Agoura Rd#270
CITY STATE ZIP
Agoura Hills CA 91301
NAME
PHONE
Fire Systems West, Inc. 253-833-1248
MAILING ADDRESS E-MAIL
206 Frontage Rd N, Suite-C service@firesystemswest.com
CONTRACTOR
CITY STATE ZIP FAX
Pacific WA 98047
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
FIRESWI055LW 06 31 18 19-87-000014-00-BL
NAME PRIMARY PHONE
Same
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT Matt Carlman
253-951-6005
(The individual to receive and MAILING ADDRESS EMAIL
respond to all correspondence Same mattc@firesystemswest.com
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING ❑ OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27.095)
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in
the investigation and defense of such claim),which may be made by any person,including the undersigned, and filed against the city,
but only where such claim arises ut of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city a part of this application.
SIGNATURE: DATE 11/28/2017
PRINT NAME: Matt Carl. an
Bulletin#100—January 29,2016 Page 1 of 2 k:AHandouts\Pennit Application